Nuffield Health The Manor Hospital Oxford

Updated 17 June 2022

Nuffield Health The Manor Hospital Oxford is operated by Nuffield Health Group. Hospital facilities include 25 consulting rooms, six surgical theatres, 68 private en-suite bedrooms, two minor procedure suites and a radiology unit including: mammography, ultrasound, MRI & CT scans. There was also a seven bedded adult critical care unit, a physiotherapy department and two intervention suites for radiology and cardiology. The children and young people’s inpatient service had six single en-suite rooms in one dedicated area and saw patients over the age of three. Children and young people were also treated in outpatients from birth. The endoscopy unit consisted of treatment suites, one patient bay, a scope washer and drying room, a patient recovery area, and staff offices. The oncology unit had a patient bay with space for seven patients, two side rooms with en-suite facilities and a quiet room run by a charity.

The hospital provides surgery, medical care, critical care, services for children and young people, outpatients and diagnostic imaging. The hospital is currently registered for the regulated activities surgical procedures, diagnostic and screening procedures, and treatment of disease, disorder or injury.

The main service provided by this hospital was surgery. Where our findings also apply to other services, we do not repeat the information but cross-refer to the surgery service.

Updated 17 June 2022

• The overall rating for this hospital remained the same, we rated it good.
• The hospital had enough staff to care for patients and keep them safe. Staff across services assessed risks to patients, acted on them and kept good care records. The service managed incidents well and learned lessons from them. Services across the hospital were visibly clean.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of services. Staff worked well together for the benefit of patients, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff across all services treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers. Staff in services for children and young people had an outstanding culture of providing care and treatment, especially emotional support for patients with phobias and learning disabilities.
• Services across the hospital planned care to meet the needs of the communities it served, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for procedures. Services for children and young people provided outstanding support for LGTBQIA2S+ patients.
• Leaders ran services well and staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services.

However

• At the 2016 inspection, outpatients and diagnostic imaging were rated together. At this inspection we rated them as separate core services. The rating for diagnostic imaging went down to requires improvement. In response we have served two requirement notices, one for safe care and treatment and another for good governance.
• The hospital had carpets in clinical areas across services. This was reported in the 2016 CQC report, and was preventing the endoscopy service from being accredited. Although the pace of change was slow, there were good infection prevention and control practices in place to keep patients safe until the refurbishment was completed.
• Staff in the surgery, outpatient and diagnostic imaging departments did not have key skills, including understanding how to protect patients from abuse. Mandatory training completion rates for these departments was below the hospitals target, including safeguarding adults and children.
• Staff in the diagnostic imaging department did not always control infection risk well. Personal protective equipment was not always effectively used and staff did not follow policies and best practice.
• Staff in the diagnostic department did not always manage medicines well. Storage and administration of medicines was not in line with guidance.
• The hospital was developing a system for monitoring patients that did not attend their appointment, however this was not in place at the time of inspection.
• The hospitals management team acknowledged further development was required to support patients with dementia.
• Governance systems in diagnostic imaging did not ensure policies, procedures and guidance was up to date, ratified and reviewed regularly.

Updated 17 June 2022

Our rating of this service stayed the same. We rated it as good because:

• The services we visited were visibly clean and there were good infection prevention and control practices in place.
• The services had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, provided advice to them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The services planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The endoscopy service had started working towards achieving the Joint Advisory Guidance (JAG) accreditation in 2016. The same issues prevented them from meeting the required criteria, namely the carpeted flooring.

Updated 17 June 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for children and young people and keep them safe. Staff had training in key skills, understood how to protect children and young people from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to children and young people, acted on them and kept good care records. They managed medicines well. The service managed incidents well and learned lessons from them.
• Staff provided good care and treatment, gave children and young people enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of children and young people, advised them and their families on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• The service had a strong, visible person-centred culture. Staff were highly motivated and inspired to offer care that was kind and compassionate. Staff treated children and young people with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided outstanding emotional support to children and young people, families and carers.
• The service had an excellent understanding of children and young people’s social and cultural diversity, values and beliefs that may influence their decisions on how they want to receive care, treatment and support. Staff knew how to meet these preferences and were innovative in suggesting additional ideas to meet those needs. Staff actively encouraged children and young people to give their views and raise concerns or complaints. The services saw concerns and complaints as part of driving improvement. Children and young people could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well and staff felt respected, supported and valued. They were focused on the needs of children and young people receiving care. Staff were clear about their roles and accountabilities. The service engaged well with children, young people and the community to plan and manage services and all staff were committed to improving services.

However:

• Some flooring in clinical areas were carpeted which did not follow best practice.
• The vision and strategy for the department was not fully embedded with staff.
• We found some out of date medical consumables not identified using the services checking system.
• There was no method for monitoring children and young people’s appointment attendance, although a system was being developed.

Updated 20 December 2018

Critical care services had been reinstated in April 2018. The hospital had a seven-bedded critical care unit, which was staffed with the capability of providing Level 2 and Level 3 care. This was a new service and formed a small part of hospital activity.

We rated this service as good because it was safe, effective, caring, responsive and well-led.

Updated 17 June 2022

Our rating of this service went down. We rated it as requires improvement because:

• There were shortfalls in mandatory training for staff. Staff mandatory training compliance was 62%, this was below the service target of 95%
• The service did not always control infection risk well.
• Not all staff had received training on how to protect people from abuse in line with national guidance.
• Staff did not always understand how to protect patients from abuse.
• The service did not always manage safety incidents well or learn lessons from them.
• They did not always manage medicines well.
• The service did not take account of all patients’ individual needs and there were limited support services for patients with a learning disability or for those living with dementia.
• Staff did used policies and procedures that were not the most recent versions and there were limited measures in place to update these in line with review dates.

However:

• The service had enough staff to care for patients and keep them safe. Staff assessed risks to patients, acted on them and kept good care records.
• Staff provided good care and treatment, gave patients enough to drink.
• Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, and had access to good information. Key services were available to suit patients' needs.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of the communities it served, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for procedures.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities.

Updated 17 June 2022

Our rating of this service stayed the same. We rated it as good because:

• The service had enough staff to care for patients and keep them safe. Staff had training in key skills, understood how to protect patients from abuse, and managed safety well. The service-controlled infection risk well. Staff assessed risks to patients, acted on them and kept good care records. They managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• The provider should ensure resuscitation equipment needs are reviewed for the department. (Regulation 12).
• The provider should ensure monitoring processes for patients who did not attend their appointment are reviewed. (Regulation 12)
• The department should review risks associated with carpets in the consultation rooms.
• The department should review the layout of the department meeting minutes so that incidents are clearly identified and discussed with the team.
• The department should consider the arrangements for recording meetings with their cardiology outpatients’ team.
• The department should consider improvements in mandatory training be built upon to reach the provider’s minimum targets for all modules.

Updated 17 June 2022

Our rating of this location stayed the same. We rated it as good because:

• Managers regularly reviewed and adjusted staffing levels and skill mix to keep patients safe from avoidable harm and to provide the right care and treatment. The service used agency staff and bank staff and gave staff a full induction.
• Staff had access to training in key skills, staff understood how to protect patients from abuse, and managed safety well. The service controlled infection risk well. Staff assessed risks to patients, acted on them and mainly kept good care records. They mainly managed medicines well. The service managed safety incidents well and learned lessons from them.
• Staff provided good care and treatment, gave patients enough to eat and drink, and gave them pain relief when they needed it. Managers monitored the effectiveness of the service and made sure staff were competent. Staff worked well together for the benefit of patients, advised them on how to lead healthier lives, supported them to make decisions about their care, and had access to good information. Key services were available seven days a week.
• Staff treated patients with compassion and kindness, respected their privacy and dignity, took account of their individual needs, and helped them understand their conditions. They provided emotional support to patients, families and carers.
• The service planned care to meet the needs of local people, took account of patients’ individual needs, and made it easy for people to give feedback. People could access the service when they needed it and did not have to wait too long for treatment.
• Leaders ran services well using reliable information systems and supported staff to develop their skills. Staff understood the service’s vision and values, and how to apply them in their work. Staff felt respected, supported and valued. They were focused on the needs of patients receiving care. Staff were clear about their roles and accountabilities. The service engaged well with patients and the community to plan and manage services and all staff were committed to improving services continually.

However:

• Compliance with mandatory training was low in some areas due to a pause in training due to Covid 19.
• Some policies and procedures were generic in nature and did not reflect local practices.